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STEP > Neuro VI > Flashcards

Neuro VI Flashcards

1
Q

Common causes of noncommunicating hydrocephalus?

A

1) stenosis of aqueduct of Sylvius
2) colloid cyst blocking foramen of monro
3) tumors

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2
Q

Differentiating ex vacuo ventriculomegaly from hydrocephalus

A

ICP normal in ex vacuo ventriculomegaly

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3
Q

Common causes of ex vacuo ventriculomegaly

A

1) AD
2) advanced HIV
3) Pick disease

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4
Q

Total # of spinal nerves and breakdown

A 
31
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
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5
Q

Rules about where nerves exit

A

1) C1-C7 exit above corresponding vertebra.
2) C8 exits below C7 and above T1.
3) All other nerves exit below (eg C3 exits above 3rd cervical vertebra; L2 exits below 2nd lumbar vertebra)

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6
Q

most common locations of herniated disc

A

L4-L5

L5-S1

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7
Q

Where does spinal cord end in adults?

A

Lower border of L1-L2

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8
Q

Where does subarachnoid space extend to in adults?

A

Lower border of S2 vertebra.

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9
Q

LP location?

A

L3-L5, keep the cord alive.

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10
Q

Gracilis vs. cuneatus

A

Organized as you are with Arms and hands outside, legs inside.

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11
Q

If you see a sympathetic horn what does that tell you?

A

Between T1 and L2/L3

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12
Q

Tract locations in spinal column…

A

FA 472

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13
Q

Organization of lateral spinothalamic tract…

A

Sacral out wide, cervical medial.

*Legs lateral.

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14
Q

anterior vs. lateral spinothalamic tract

A 
Lateral = pain, temperature
anterior = crude touch, pressure.
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15
Q

lateral corticospinal tract organization

A

sacral lateral, cervical medial.

*legs are lateral

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16
Q

ascending vs. descending pathways

A

dorsal column + spinothalamic tracts carry ascending information.
CS tract carries descending information.

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17
Q

location of crosses in tracts

A

Ascending tracts (dorsal column, spinothalamic) synapse and then cross.

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18
Q

Dorsal column pathway

A

1st order neurons are sensory neurons with cell body in DRG –> enters spinal cord, ascends ipsilaterally in dorsal column –> synapses with ipsilateral nucleus cuneatus or gracilis in the medulla –> 2nd order neuron decussates in medulla –> ascends contralaterally in medial lemniscus –> synapse 2 on VPL in thalamus) –> 3rd order neuron projects to sensory cortex.

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19
Q

Spinothalamic tract pathway

A

sensory nerve ending (alpha delta or C fibers) has cell body in dorsal root ganglion, enters spinal cord –> synapse 1 in ipsilateral gray matter in spinal cord –> decussates at anterior white commissure –> ascends contra laterally –> synapses on VPL in the thalamus –> 3rd order neuron projects to sensory cortex.

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20
Q

Lateral CS tract pathway

A

UMN neurons have cell bodies in motor cortex –> descend ipsilaterally through IC –> most fibers decussate at caudal medulla (pyramidal decussation) –> descends contra laterally –> synapses on cell body of anterior horn in spinal cord –> LMN leaves spinal cord and synapses at NMJ.
**2 neuron pathway.

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21
Q

Weakness: UMN or LMN sign?

A

both

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22
Q

Muscle tone in UMN and LMN

A

Increased with UMN, decreased with LMN

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23
Q

spastic and flaccid paralysis for UMN and LMN

A

spastic paralysis = UMN lesion

flaccid paralysis = LMN lesion

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24
Q

syndromes affecting anterior horn?

A

1) polio

2) werdnig-Hoffmann

25
Q

werdnig-Hoffmann prognosis

A

Median age of death of 7 months

26
Q

Difference in presentation with polio vs. werdnig-Hoffmann

A

Polio –> asymmetric weakness

werdnig-Hoffmann –> symmetric weakness

27
Q

Where will ALS affect spinal cord?

A

Combined UMN and LMN, so anterior horn + lateral CS tract

28
Q

ALS presentation

A

1) asymmetric limb weakness (hands/feet)
2) fasciculations
3) eventual atrophy
4) *preserved sensory and bowel/bladder functions

29
Q

ASA occlusion presentation on spinal cord cutout?

A

Everything affected except dorsal columns and Lissauer tract

30
Q

What is the watershed area with ASA and why?

A

Upper thoracic territory because artery of Adamkiewicz supplies ASA below T8

31
Q

Tabes dorsalis affects…

A

posterior column.

32
Q

Tabes dorsalis pathophys

A

demyelination of dorsal columns and roots leading to progressive ataxia.

33
Q

tabes dorsalis exam

A

1) positive romberg sign

2) absence of DTRs

34
Q

tabes dorsalis associations

A

1) charcot joints
2) shooting pain
3) Argyll Robertson pupils

35
Q

subacute combined degeneration presentation

A

1) ataxia
2) paresthesia
3) impaired position/vibration sense

36
Q

How does polio virus get around?

A

Replicates in oropharynx and small intestine then spreads via bloodstream to CNS.

37
Q

How do you recover polio virus?

A

from stool or throat.

38
Q

CSF findings in poliomyelitis?

A

1) increased WBCs

2) slight increase of protein

39
Q

What is frataxin?

A

iron binding protein

40
Q

cell bio problem with Friedrich’s?

A

impaired mitochondrial functioninig

41
Q

Childhood presentation of Friedrich’s?

A

Kyphoscoliosis

42
Q

What is brown-sequard?

A

Hemisection of spinal cord

43
Q

brown-sequard presentation

A

1) ipsilateral UMN signs below level of lesion
2) ipsilateral loss of tactile, vibration, proprioception sense below level of lesion
3) contralateral pain and temp loss below level of lesion (due to spinothalamic tract damage)
4) Ipsilateral loss of all sensation at level of lesion
5) Ipsilateral LMN signs at level of lesion
6) Horner syndrome if above T1

44
Q

Horner syndrome and brown-sequard pathophys

A

Due to damage of oculosympathetic pahway

45
Q

Whee is gallbladder pain referred to?

A

right shoulder via phrenic nerve.

46
Q

Referred right shoulder pain think…

A

Diaphragm or gallbladder

47
Q

C2 dermatome

A

posterior half a skull cap

48
Q

C3 dermatome

A

high turtleneck shirt

49
Q

C4 dermatome

A

low-collar shirt

50
Q

C6 distribution

A

thumbs

51
Q

T4

A

nipple

52
Q

T7

A

xiphoid process

53
Q

T10

A

umbilicus

54
Q

L1 location

A

inguinal ligament

55
Q

kneecap dermatome

A

L4

56
Q

Dermatomes related to erection and sensation of penile and anal zones?

A

S2,3,4.

S2,3,4 keep the penis off the floor

57
Q

triceps reflex

A

C7,8 “C7,8 lay them straight

58
Q

cremaster reflex nerves

A

L1,L2– “testicles move”

59
Q

anal wink reflex nerves

A

S3,S4 “winks galore”

STEP (85 decks)

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